RPL (10-0477)61386 Living Stone Dr
10-0477
Application Number- 10-00000477,
Property Address: 61386 LIVING STONE DR _
APN: 764-2807999-19.2 -300236
Application description. POOL - RESIDENTIAL
Property Zoning: MEDIUM HIGH DENSITY RES.
Application valuation: 32000 %;
Architect
PW
4
'BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
0t0Z %_ t4'ii
c is ;
'LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B C27 C53 License No.: 810111
��uactor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: '
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,'
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden'of proving that he or she did not build or
improve for the purpose of sale.).
( •_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7644, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, 'v. C.).
Lender's'Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/03/10
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code,, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number -290-0001790
I certify that, in the performance of. the work for which this permit is. issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become 'ect to the workers' compensation provisions of Section
3700 of the Labor Code, 1 orth h comply with those provisions.
/Date: 1� pplicant:
WARNING: FAILURE TO SECLJPE W KE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT, Application is hereby made to the Director of Building and Safety for a permit subject to the
-
conditions and restrictions set forth on this -application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed underor pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. '
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days' from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. 1 agree to comply with all
_ city and county ordinances and state laws relating to buildingrwkstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr or ins ection ur oses.
ate:`14 io Sature (Applicant or A
Owner:
BILL & MAE HENLEY
61386 LIVING STONE DRIVE.
--
LA QUINTA,. CA 92253
r�
Contractor:
PICASSO POOLS INC
r
41800 WASHINGTON ST B105-433
BERMUDA DUNES, CA 92203.
�I
(760)345-4600
Lic: No.: 810111
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code,, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number -290-0001790
I certify that, in the performance of. the work for which this permit is. issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become 'ect to the workers' compensation provisions of Section
3700 of the Labor Code, 1 orth h comply with those provisions.
/Date: 1� pplicant:
WARNING: FAILURE TO SECLJPE W KE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT, Application is hereby made to the Director of Building and Safety for a permit subject to the
-
conditions and restrictions set forth on this -application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed underor pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. '
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days' from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. 1 agree to comply with all
_ city and county ordinances and state laws relating to buildingrwkstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr or ins ection ur oses.
ate:`14 io Sature (Applicant or A
Application Number
10-00000477
-
Permit
ti
BLDG POOL PERMIT
Additional-desc .
Permit Fee
297.50 Plan Check Fee
193.38
Issue. Date
Valuation
3200A
Expiration Date
11/30/10
Qty Unit Charge'
Per_
Extension'
BASE FEE:
252.00
7.00 6.5000
THOU BLDG 25,001-50,000
45.50_
Permit
MECH POOL
Additional desc .
Permit Fee
26.00 Plan-Check Fee
6.50
Issue Date,
Valuation
0
' Expiration Date
11/30/10
Qty. Unit Charge
Per
Extension
BASE-FEE
15.00.
1.00 11.0000
EA' MECH FURNACE >100K
11.00
Permit
ELEC POOL PERMIT-RES
Additional desc .
Permit Fee
45.00 Plan Check Fee
11.25
Issue Date.
Valuation
0.
• -Expiration Date
11/30/10
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
1.00 30:0000.EA
ELEC PRIVATE SWIMMING POOL
30.00
Permit
PLUMBING
Additional desc
Permit Fee . . . .
33.00 Plan Check Fee
8.25
Issue Date:
Valuation
0
Expiration Date
11/30/10:
Qty Unit Charge
Per
Extension
BASE FEE'
15.00
2.00 6.0000
EA PLB FIXTURE
12:00
1.00 3:0000
EA' PLB WATER INST/ALT/REP
3.00
1.'00 3.0000
EA PLB GAS 'PIPE 1-A OUTLETS
3.00
Permit . . . ...WALL/FENCE
PERMIT
1`
LQPERMIT
',
Application Number . . . . . 10-00000477
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 15.00. Plan.Check
Fee
.00
Issue Date -Valuation
288
Expiration Date 11/30/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
POOL/SPA; 17'8" 4' EQUIPMENT.ENCLOSURE,
CITY STANDARD & BBQ (NO.SINK).
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. 2007 CODES.
-------------------------------------------------------------------
Other Fees . . . . . : .BLDG STDS.ADMIN (SB1473)
2.00
Fee summary Charged ...Paid Credited
Due
Permit Fee Total 416.50 00
.00
416.50
Plan Check.Total 219.38 .00
.00
219.38
- Other Fee.Total 2.00 .00
.00
2.00
Grand Total. 637.88 .00
.00
637.88
Total Permrt:Fcu
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AFIPUCANT: DO NOT WRI-1 B `1O W THIS LINE
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Plans rnubmirrcd
Cons[ructi.nn `
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!�ieenanical
5Docnnactor Lis[ I I
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Called Contact Pr=son
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Total Permrt:Fcu
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